Comparison of the use of morphine bolus and using a portable infusion pumps for pain management in patients after coronary artery bypass grafting surgery (CABG)

Pain control in patients after coronary artery bypass surgery is the purpose of this study. Sixty eight patients (aged 30-65 years), with 3-vessel disease (3VD), ejection fraction greater than 40% who undergone coronary artery bypass surgery using a heart-lung pump will be entered in the study. One mg oral Lorazepam at the night before surgery and 1 hour before transfer to the operating room and 1 mg/kg intramuscular morphine half an hour before transfer to the operating room given to patients for sedation. All patients underwent coronary artery bypass grafting surgery with the same technique using heart-lung pump arranged.After surgery, patients transferred to cardiac intensive care with tracheal tube and underwent to mechanical ventilation. Patients separate from ventilator and the endotracheal tube is removed between 6-8 hours. Then, patients divide into two equal groups after extubation. For patients in group P, PCA pump containing 3 ampoules of morphine is equivalent to 30 mg infused with speed of 0.02 mg/kg/h. In group M, 0.03 mg/kg bolus morphine given to patients with VPS>3 and repeated 3 times in 1 hour if pain not controlled. Group M will receive infusion of normal saline as placebo. If pain is not controlled after administration of morphine in two groups, intravenous Apotel and Diclofenac suppository are used.In both groups, every 2 hours for 12 hours and then every 4 hours to 24 hours, vital signs including blood pressure and heart rate, pain on the VPS score (Verbal pain scale) and the incidence of complications such as hypoxia, sedation and gastrointestinal effects assessed and recorded.

Guilan University of Medical Sciences